Scrambler therapy for the treatment of diabetic peripheral n
Written informed consent was obtained by the patient for publication of this case. A 45-year-old female patient with DM was referred from the internal medicine department with a complaint of bilateral plantar foot pain. She described the pain as tingling and resembling the sensation of heat; it was worse early in the morning and late at night. At the time of her referral, she self-rated the pain intensity as 6/10 on the Numerical Rating Scale (NRS) for pain. She had been treated for DM with insulin injections for 5 years. Her glycated hemoglobin was 8.1%, and glucose level was 140 mg/dL. An electromyogram was conducted and revealed peripheral polyneuropathy. Because the result of her test was abnormal and she had typical neuropathic symptoms, she was diagnosed with stage 2a diabetic peripheral neuropathy.[8]

For her diagnosis of diabetic peripheral neuropathy, she received medication including oral pregabalin 75 mg twice a day, but her symptoms did not improve. We tried increasing the pregabalin dose, but her pain did not improve before side effects, such as dizziness and nausea, precluded further dosage increments. We then performed a bilateral posterior tibial nerve block by injecting 5 cc of 0.187% ropivacaine solution without steroids. Upon follow-up 1 week later, the patient reported that the nerve block was ineffective. We then performed a lumbar sympathetic ganglion block (LSGB) with bilateral injection of 10 cc of 0.375% ropivacaine without steroids. One week after the first LSGB, the patient reported that the LSGB effected a temporary improvement of symptoms. We then applied a second LSGB, which the patient reported to be ineffective 1 week later at the next follow-up visit.

We therefore planned for ST, which was performed using a special type of electrode with 5 channels. Because the scrambler electrodes should be positioned in areas where there is no pain, we attached the electrodes to normal sensory areas around the ankle (Fig. 1). After the placement of electrodes, an electrical stimulus was applied, the intensity of which was gradually increased to the maximum value tolerated by the patient. During treatment, the patient experienced her non-pain sensations as itching in the bilateral foot. We set up a 45-minute treatment session once a week for 10 weeks at the same time and provided by the same physician. The patient's NRS score decreased from 6/10 to 3/10 after the first ST session. Subsequent sessions were followed by marked improvement of pain. After 10 treatment sessions, the patient reported an NRS score of 2/10 for bilateral plantar foot pain. When the patient returned to the hospital one week later, the NRS score was still 2/10. After that, the patient decided to visit the hospital when she felt discomfort, but she has not come to the hospital for 6 months.

Source: Medicine: May 2019 - Volume 98 - Issue 20 - p e15695

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